Samuel A. Collins
question: I’ve noticed Medicare and VA payments increasing recently. Have the rates increased? I assumed not. What are the rates for 2024? Reduction From 2023.
Based on your question, I’m going to assume you bill for Medicare (Part B or C) and VA claims at the normal rates, and unless you follow Medicare news very closely, you probably won’t notice any rate increases.
Yes, Medicare increased rates in March. Specifically, the Medicare conversion was adjusted upward by 1.69% on March 9, 2024. This increase means approximately $1.00 to $4.00 per unit depending on manual or electroacupuncture. Reimbursement for treatment increased from 50 cents to $4.00 depending on the code, and fees for evaluation and management services increased by approximately $5 to $15. While not a significant increase, it helps offset the rate declines since the beginning of the year. These new rates apply to services provided between March 9 and December 31, 2024.
These increases are the result of the Consolidated Appropriations Act of 2024, which addressed a 3.37% reduction that took effect on January 1, 2024, increasing the conversion factor for the Medicare Physician Fee Schedule (PFS) from $32.74 to $33.29. This new conversion is used to multiply the relative value of the CPT code with the local adjustment applied.
It is important to note that when billing a Medicare or VA claim, you can bill at your regular rate with the understanding that you can only collect based on the authorized rate listed on your statement of benefits. I believe this is how you noticed the price increase. If you were billing at the contract rate, you obviously would not have noticed the increase because you would just pay what you were billed, even if the authorized rate was higher. For this reason, I recommend always billing at your regular rate with these types of plans. Assuming your regular rate is greater than or equal to the authorized rate, your reimbursement will pay you the maximum amount allowed.
If you are currently billing at pre-March Medicare rates, visit your state’s Medicare Administrative Carrier (MAC) website to find out what the new rates are, but it’s wise to bill at your regular rates so they are automatically adjusted and you don’t have to worry about finding the new Medicare rates.
If you bill more than the Medicare rate, whether it be Medicare or the VA (yes, the VA uses the Medicare rate), you will receive a notice on your EOB that says CO-45, letting you know that you are billing more than the contracted rate and that you are limited to only the permitted fee and co-payments (if applicable) listed on the EOB, but you will definitely be subject to the maximum permitted fee.
These changes also apply to plans that use Medicare as the basis for their fee schedule, and in many states, such as Florida, Michigan, and Pennsylvania, they apply directly to personal injury claims. Many states also use Medicare rates for workers’ compensation, so it’s worth reviewing any changes that may apply to your state. For example, California uses Medicare rates to determine the official medical fee schedule for California workers’ compensation. These adjustments also affect VA claims and Medicare Advantage reimbursements.
Traditionally, Medicare updates its rates in January, but as we’ve seen this year and in several previous instances, rates could be adjusted for a second time, likely due at least in part to delayed congressional votes and budget wrangling.
This is where I find the truth in what my father said. He always said, “This is why it’s called acupuncture. Practice And it’s not perfection” (He is a chiropractor and his words apply to the practice of chiropractic as well.) Changes and updates occur all the time, so continuing education is mandatory and some time is devoted to ethical coding and billing.
Editor’s note: Have a question about billing? Email Sam at sam@hjrossnetwork.com. By submitting, you accept that your question may become the subject of a future column.
